In light of the need for interventions to promote treatment adherence as well as secondary prevention of HIV, the University of Illinois at Chicago Jane Addams College of Social Work (JACSW) in partnership with the Chicago Health Outreach (CHO) and the Midwest AIDS Training and Education Center (MATEC) proposes this R21 project to develop, pilot and evaluate an innovative intervention that integrates directly observed therapy for HIV and HIV risk reduction with a marginally housed population This enhanced intervention will seek to promote not only ongoing adherence to antiretroviral therapy, but also ongoing maintenance of reduced risk behaviors The intervention--directly administered antiretroviral therapy and risk reduction (DAART+)--is rooted in the stages of change framework and Information-Motivation-Behavioral skills model The adherence/prevention objectives are integrated in a case management model that is responsive to the diverse needs of the study sample population The intervention is comprised of several different components 1) Readiness Assessment, 2) Intensive DAART+, 3) Tapered DAART+, and 4) Follow-up The goals of this developmental project for mental health intervention research include 1 To implement a case management-based DAART+ model that integrates the promotion of treatment adherence and HIV prevention for a population of marginally housed individuals 2 To acquire pilot data to determine if this DAART+ model is effective in promoting autonomous adherence to ART and the overall treatment plan of the client 3 To acquire pilot data to determine if this DAART+ model is effective in promoting autonomous maintenance of reduced risk behaviors 4 To identify which client-specific variables have an impact on the success of the intervention 5 To determine how feasible and acceptable this intervention is to clients In response to PA-99-134 this proposal represents Stage 2 and Stage 3 of an intervention planning and development effort, but with primary focus on the Stage 3 piloting (N=30) of the intervention The first 4 months of the project will focus on intervention standardization (Stage 2) and the subsequent 32 month period (approx 2 5 years) will focus on piloting the intervention (Stage 3).